Provider Demographics
NPI:1013998749
Name:ROBERTS, GWYNDELYN J (LMHP CMSW)
Entity type:Individual
Prefix:
First Name:GWYNDELYN
Middle Name:J
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:LMHP CMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17323 S CREEK CIR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68136-3163
Mailing Address - Country:US
Mailing Address - Phone:402-964-2277
Mailing Address - Fax:
Practice Address - Street 1:6720 N 30TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68112-3211
Practice Address - Country:US
Practice Address - Phone:402-451-6244
Practice Address - Fax:402-455-1064
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NELMHP 2848101YM0800X
NE11481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical